August 18, 2008

"Living Will" Becomes a License to Kill: The Horror Goes On In 2008

Editor's Note: Bill Beckman, Executive Director, Illinois Right to Life Committee, updates RFFM.org's readers regarding the issue of living wills. During the last week, RFFM.org posted a series on end of life issues which were first seen on RFFM.org in 2006. Beckman's latest column is an insightful look into the confusing and sometimes deadly result of signing a living will.

AUGUST 18, 2008

by Bill Beckman, Executive Director, Illinois Right to Life Committee *

While the Terri Schiavo case was in the news back in 2004, another Florida case got much less publicity. Hanford Pinette had signed both a living will and a durable power of attorney for health care that designated his wife as agent. When he had congestive heart failure, he needed a ventilator.

His doctors insisted he had no hope of recovery so the provisions of his living will should be exercised by removing the ventilator. When his wife Alice refused, hospital officials took the case to court and won. Even though Hanford was still conscious, doctors removed his ventilator and he suffocated within two hours.

On August 13, 2008 in Rochester, NY local TV news reported on the case of Dorothy Livadas, 97, who lives with the aid of life support. Though she had signed documents giving her daughter, Ianthe Livadas, the power to make medical, legal, and financial decisions for her, she had also signed a "living will" instructing that she be taken off life support if she lapsed into a state where there was no reasonable expectation of recovery.

The dispute over her mother's condition forced Ianthe Livadas into a five-month legal battle against doctors, attorneys, and the Catholic Family Center. "You don't expect a hospital to be threatening you that they're going to put aside your mother's choice of health care proxy and power of attorney, and replace you," Ianthe said.

Medical "experts" testified in court that there is no chance Dorothy will awaken or communicate. Livadas’ daughter disagrees. "Just the other day, I saw a sneer on her face when I mentioned someone she doesn't like very well. When you know someone all their life, you can tell what they're thinking by subtle movements in their face that others would miss," she said.

However, the courts have ruled that Ianthe Livadas no longer has a say in her mother's care as Justice Harold Galloway awarded custody to Catholic Family Center. He said that Ianthe "fails to appreciate her mother's true medical condition," and that she "lacks the objectivity and insight to make necessary decisions."

This is just the latest known case where signing a "living will" allows the medical profession to stop "life support" of a conscious individual because they have "no hope of recovery" even when the agent designated by a durable power of attorney for health care disagrees. The living will simply makes it that much easier for the medical profession to get the agent declared incompetent.

The news report did not identify whether "life support" consists simply of a feeding tube or includes a ventilator as well. From past experience, I would be suspicious that use of the generic phrase "life support" would likely indicate that only a feeding tube was involved. If that be true, they plan to starve Dorothy to death because doctors have agreed she has "no reasonable expectation of recovery." That is called euthanasia!

At the same time, more debate is occurring about the ability of the medical profession to establish the mental capabilities of disabled patients using their traditional approaches.Michael Egnor, M.D., professor of neurosurgery and pediatrics at State University of New York, contends that the diagnosis of persistent vegetative state, in Terri Schiavo’s case specifically, and in other cases more generally, is of dubious validity.Dr. Egnor references a study of the brain of a PVS (persistent vegetative state) diagnosed patient that reveals mental activity almost identical to that of conscious volunteers who were given the same instructions.

The results suggest that patients diagnosed as PVS are truly conscious.Those findings certainly support the contentions of Alice Pinette about her husband’s responses and Ianthe Livadas about her mother’s responses, even though in both cases medical professionals testified in court that they were unresponsive so their living wills should be enforced.

Would you want your “living will” enforced when you are still conscious?Do not ever sign a “living will” because it amounts to a license to kill you!

Dr. Egnor describes the Cambridge testing scenario as follows:

In the September 2006 issue of Science, Dr. Owen and his Cambridge colleagues published a study entitled "Detecting Awareness in the Vegetative State." Owen and his colleagues studied the responses of a woman who was in a persistent vegetative state, which was the consequence of severe diffuse brain damage that she had suffered in an automobile accident the year before.

The patient had no evidence of any mental function. Based on a battery of standard tests, including MRI scans, electroencephalograms (EEG’s — brain wave tests), and careful bedside examinations by neurologists and neurosurgeons, she was diagnosed as being in a persistent vegetative state. Persistent vegetative state means that she had no mental state — no consciousness. She was, in a sense, a shell, a human body without a mind. That’s what "vegetative" means.

Owen and his colleagues did a fascinating series of tests. First, they asked a group of normal volunteers to have a kind of research MRI scan of their brain, called a functional MRI (fMRI). fMRI doesn’t measure the actual activity of the neurons in the brain, but it measures the blood flow and brain metabolism in specific regions of the brain. It has been found to correlate to some extent with mental activity. Thinking about things can make the metabolism in certain parts of the brain increase, and fMRI can detect this. The observation that brain activity can locally increase brain blood flow and metabolism was originally made a century ago, in animals in the lab, so it’s not new. What is new is that we can now measure it in living people non-invasively, using fMRI.

The Cambridge researchers asked the volunteers to think of things, like playing tennis or walking across the room, and they recorded their fMRI brain responses. They also presented the volunteers with nonsense words, to distinguish understanding in the brain from the mere reflex to sounds. The response to understanding was different from the response to sound. The fMRI test seemed to test understanding, not just reflexes.

They did the same tests to the woman who was in a persistent vegetative state. They asked her to imagine playing tennis or imagine walking across the room, and they did the sham test with random words as well.

When they examined her fMRI responses, they found that her fMRI patterns were identical to those of the normal awake volunteers. By fMRI criteria, she understood. In fact, by fMRI criteria, she was as conscious as the normal volunteers. Her brain was massively damaged, to the extent that she had been diagnosed as having no mind at all. Yet the blood flow and metabolism patterns in her brain were those of a normal person. And just like normal people, she showed different fMRI responses to nonsense words. So she not only heard what was said to her, but she understood, and complied with the researchers’ requests to think about specific activities like playing tennis and walking across a room.

Owen’s study generated enormous interest among researchers, physicians and the public, not only for its implications for diagnosis of persistent vegetative state (e.g. the implications for the Terri Schiavo case), but because of what it suggests about deeper questions about the relationship between the mind and the brain. Many other studies of fMRI in patients in persistent vegetative state are underway, and several studies recently completed with other patients tend to support Owen’s findings.

Comments

This is an extremely good topic. My mother just passed away after 4-5 weeks in ICU. She had signed a Living Will but we kept her on a ventilator because there was hope. At one point she was off the ventilator and started choking from vomit and stopped breathing. My sister was ABSOLUTELY HYSTERICAL because she did not let my mother die at that point. Back on the ventilator she lived for a few more weeks and outstanding things happened in regard to our relationship. It's all a very long story, but Living Wills are a nightmare.

I have put my husband and children in charge of my future should I not be able to act upon it ... it's a big relief all around. I think Living Wills are very selfish. I wasn't ready to say goodbye to my mom when she first needed a ventilator ... the extra 4 weeks or so of hope, prayer, and connecting with my mother I wouldn't give up for anything. And I'm certain she now feels the same way too.

Great article. We just concluded two months in two different hospitals fighting for my grandmother's life who was on a ventilator. Thank the Lord, she did not have a living will and my mom had POA. Those two months were a trial yet a great blessing. In times of sickness, never give up.

Yes! Living Wills are distributed through packages given to patients in the hospitals and physicians' offices and emergency rooms and there is NO notice provided that informs that under federal and state law, there is NO requirement that incoming patients provide a living will or Power of Attorney to the hospital. Under the law, patients are assumed to be in full code status UNLESS they revoke their full code status with an advanced directive/living will and agree to the shortening of their lives, whether or NOT the refused treatment is deemed medically futile by the hospital.

I believe that misuse of DNR Code Status among elderly Medicare patients is epidemic.

The hospitals/physicians use the Living Wills to extrapolate DNR code status into the hospital charts of patients which then allows them to limit further treatment when they KNOW that Medicare and private insurers will not reimburse for further treatment because of non beneficial over treatment, mistakes, errors, and when the patient has exceeded the Diagnosis Related Group Cap for the cancer/disease that is being treated.

Pretty ugly stuff going on under the radar of public scrutiny but it is NOT a political thing. This has been going on for years under both political parties but it is too politically explosive and neither party wants to bring it to the public's attention. .